The selection of cases for endodontic therapy should
take into consideration the prognosis of the
endodontic, restorative and periodontal procedures.
4
The flow chart (Fig 1) provides a diagrammatic
outline of the decision-making process for treatment
planning in endodontics. Once appropriate diagnostic
tests have confirmed the pulpal and periradicular
diagnosis, immediate treatment of the tooth may be
required if relief of painful symptoms is needed. For a
patient in pain, the dominating concern by the dentist
is whether endodontic treatment will rapidly and
predictably eliminate the patient’s pain and
discomfort.
5
Following stabilization of the tooth, the
dentist should exercise caution in deciding whether the
tooth concerned has a good or poor prognosis. Issues to
consider when making this judgement include:
(1) strategic value of the tooth; (2) periodontal factors;
(3) patient factors; and (4) whether the tooth can be
restored or are there alternative replacement options.
Although certain teeth are endodontically treatable, the
amount of tooth structure remaining may not be
readily restorable, and a durable coronal restoration is
not achievable.
Of equal importance, the periodontal
condition of the tooth must be assessed prior to
endodontic therapy because optimal periodontal health
is critical to the long-term success of teeth that are
endodontically treated.
It is essential to consider the
patient’s needs, attitude and willingness to accept
treatment.
The clinician should also take into account
the patient’s medical condition and motivation to
maintain oral health.
The above considerations will aid the dentist in
determining whether a tooth can be preserved via
endodontic therapy or whether it is in the best interests
of the patient to consider extraction and possibly a
prosthetic replacement.
Both the dentist and patient
must agree on the definitive plan. If the tooth is
extracted, replacement options such as removable
dentures and conventional bridgework are well known
to the profession. Developments in the field of
implantology and adhesive dentistry have also
increased the options available for patients.
If the dentist and patient agree to retain the tooth, the next
question is to decide whether to refer the patient to an
endodontist.
The dentist should consider whether he
or she possesses the necessary skills and knowledge to
perform endodontic treatment for this particular tooth
to a high standard. The components of the treatment
planning flow chart (Fig 1) will be considered
individually in greater detail.